Individual
SHONDA RENNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 WOODLAND AVE, PLAINFIELD, NJ 07060-3362
(908) 753-1113
Mailing address
563 E FRONT ST APT B, PLAINFIELD, NJ 07060-1411
(908) 561-0762
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA46TA09032200
NJ
Other
Enumeration date
11/18/2010
Last updated
11/18/2010
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